Those of you who know my background know that I spent the first 10 years of my career working in various manufacturing sectors (including GM, Dell, and Honeywell). I moved into healthcare in 2005, part of the wave of people who are transferring the Lean methodology of management and quality improvement into an industry that needs it greatly, given the patient safety problems, rising costs, and oft-disengaged workforce.

I generally hear my fair share of what I call “factory bashing,” primarily from professionals who have only seen a factory on TV. When people say, “we don’t want this hospital to be some sort of factory,” I am sympathetic that they picture something like the bleak factory that Family Guy’s Peter Griffin works in…
Peter Griffin’s job at a toy factory, shown below, looks a lot like a scene out of Charlie Chaplain’s movie Modern Times, as parodied here in my fake “Wii Lean” game last year.

Sadly, this is what healthcare professionals are often afraid of when they hear of methods from “Lean Manufacturing” coming into healthcare. I can’t fault people if they’ve never been to a factory. Rather than getting upset, I try to talk to them about what bad factories are like and what great factories are like.

Now, many healthcare people HAVE gone to Lean factories and they’ve seen that a world-class western factory is nothing like the sweatshops of days gone by. When I first started my career at GM, UAW workers would bemoan that management only viewed them as a back, arms, and legs — without a brain attached. That was one of the primary reasons that GM was so screwed up, in my opinion – that general disrespect for the workers.

ThedaCare learned from a snowblower maker, Ariens, that better healthcare quality was possible. Seattle Children’s learned from Toyota that Lean was about engaging all employees in quality improvement and the best patient care (stay tuned for a Healthcare Value Leaders Network podcast that I did with their President & COO Pat Hagan, due out on 3/31). I’ve been with hospital leaders who visited VIBCO, a Rhode Island manufacturer where everybody is engaged in continuous improvement and workers use their brains as much as they use their hands and backs. The hospital leaders desperately wanted to duplicate that culture in their own hospitals.

So one point I usually make is that “like a factory” is far too general of a statement to make. There are, in this world, a wide range of factories – anything from from sweatshops to world-class factories that are outstanding workplaces for hourly and salaried workers alike.

The expression should really be “We don’t want this hospital to be some sort of awful sweatshop factory where workers aren’t listened to.” Then again, I’ve heard many complaints from healthcare professionals that managers don’t care what they think and that they are supposed to “just shut up and do their job” (a real quote, I’ve sadly heard in factories and hospitals).

So I won’t bash hospitals in somes sort of blanket statement. I’d hope healthcare professionals would extend the same courtesy to factories.

I am more than sympathetic to Joel Johnson’s points that Foxconn sounds like an awful place to work. Workers allegedly had to work 13 days straight for 12 hours a day to get the iPads out to market. Workers have to raise their hand to go to the bathroom. 17 workers have committed suicide. It does give one pause if our American addiction to gadgets and corporate “see no evil, hear no evil” offshoring practices are leading to inhumane working conditions for many. Apple does annual supplier audits… but I imagine these are like Joint Commission visits to hospitals, where all of their guidelines (such as no equipment stored in hallways) are ALWAYS followed (unlike the other 364 days a year in many hospitals).

Hospitals should NOT be like Foxconn factories, let’s make that clear. There’s no “respect for people” being demonstrated there, so these factories are arguably the furthest thing from “Lean.”

In the WIRED piece, Johnson wildly extrapolates from what he’s read about Foxconn to what he supposes factories are generally like. He apparently has the pop-culture view of factory life. I was about to suppose that he has never been to a factory, a Chinese sweatshop or an American Lean factory, but he writes in the piece that he’s eaten in the Foxconn cafeteria.

In the piece, he first writes:

“[Working at Foxconn] seems incredibly boring – like factory work anywhere in the developed world.”

That’s an incredibly unfair generalization.

He then adds:

“But the work [at Foxconn] isn’t inhumane – unless you consider a repetitive, exhausting, and alienating workplace over which you have no influence or authority to be inhumane. And that would pretty much describe every single manufacturing or burger-flipping job ever.”

Wow, that’s incredibly unfair and misguided. Try telling Toyota, Autoliv, or VIBCO workers that they have no influence or authority. Hell, not all fast food or restaurant jobs are like that, if you remember my post about Nick’s Pizza & Pub in Illinois.

Unlike some writers, I’ve actually been to Nick’s and I’ve met Nick himself. I’ve talked to many of his workers and his workplace exhibits the same respect for people and investment in people’s job development as any Lean workplace. The chain In-N-Out seems to have a great culture where employees have a voice (it should be noted I have only eaten there… often). So you can’t even bash all “burger flipping” jobs with a broad brush.

As you can tell, I’m really disappointed with the WIRED piece. To those reading… if you have a chance to visit a great factory in your community, PLEASE do so. I think you’ll be pleasantly surprised at what you see, if they are a top-notch Lean facility. You are not going to see something like Foxconn or Lucy’s chocolate factory… so let’s please stop unfairly ripping an entire industry, especially if you have never set foot inside a factory.

I have been to factories that rival the cleanliness of hospitals in many cases. How do they think those tolerances of less than a strand of hair are held? They certainly are not done where a a few molecules of dirt or even dust resides!

When I visit most other facilities to include food and health-care facilities, I seldom see the same care and commitment that I see at most factories. I think factories are cool! And amazed every time I visit one.Joseph T. Dager recently posted..ASQ Columbus Spring Conference will host Marketing with Lean

Yes, many factories are cool! And some hospitals are awful working environments. It’s hard to generalize.

I have seen many hospital jobs that sadly fit this description:

“repetitive, exhausting, and alienating workplace over which you have no influence or authority”

I’ve watched a woman get arthritic hands from doing mind-numbingly repetitive work in a hospital pharmacy, filling syringes for children’s medication over and over and over in a very manual way. Her workbench wasn’t at all ergonomically designed as she hunched over her work. She certainly didn’t have a say in any sort of improvement program and she didn’t have any authority to redesign her job… just doing the same thing over and over and over.

So this isn’t a “factories are bad, hospitals are good” type of situation at all. It’s “good management styles versus bad management styles” that is a more valid comparison. And no industry has a monopoly on bad management styles, I’d assume.

All the more reason for Joel Johnson to not lump all factories into the “bad management” category.

I love visiting factories, big machines, the process of making, and the gears behind our consumer society are incredibly interesting. But I don’t think it’s too large of a generalization to say that factory work is a boring. I only did it for about six weeks one summer in college, making a precision optical instrument, and it was extremely dull work even though the product and the process were interesting.

Of course people have different expectations for how much they want to use their brains at work and that is totally fair as long as you have some choice about what to do with your life. When there is no choice, that’s when the stereotypes amplify. This has to do with management but also regional economics, I’m sure in hospitals as well as in factories.Daniela recently posted..Achieving Net-Zero Through Power Purchase Agreements

I’m sorry that one factory was boring to you… but I’d still argue that it is a huge generalization to say that all factories are boring. You’re extrapolating from six weeks of experience with one factory.

Were the managers in that engaging you, at all, in how to do the work better? That’s what Lean is really about and it makes for a better work environment. Even repetitive work (which isn’t for everyone) can be made more interesting when your brain is engaged in continuous improvement.

Nice article and I agree, Healthcare professionals have always seen that healthcare is SO much more complex when really they don’t always know how other industries work. Reviewing an organisation (Baldridge winner) in another industry I think it gives us an appreciation of how processes could be run. Many lean concepts maybe fairly new to US Hospitals but to all other industries (where more competition) efficiency and process optimization is part of normal operations. There is SO much more Healthcare can learn from other industries, we just need to be open minded.

Okay, Mark, I’ll be another anecdote. I worked in a factory for four summers, and it was boring and repetitive (though not cruel). That does not allow me to generalize and say that all factories are boring, but I think that few people take generalizations literally to the extreme (except for the people that want to create a straw man to bash). At any point in your “10 years in the manufacturing sector” did you actually do line work, or were you a manager/executive the whole time?

No, I did not work on the line, other than a few hours when the UAW allowed me to do so for training and relationship building with the hourly workers. I have always been an engineer or manager.

The writer could have not made an extreme generalization. He could have said “many” factories, but he wrote about all and every. He writing seems to be representative of a certain brand of snobbery that says factories are full of knuckle draggers who don’t know how to create a positive work environment.

Did your factory work to engage you in any sort of improvement efforts? Did you have a voice? If not, that’s exactly what we’re trying to help improve with Lean.

Two data points does not mean that all factories are horrible and that people should look down their noses at manufacturing, as many writers in the “new economy” mindset tend to do.

BTW, it was Joel that created the “all factories are boring and inhumane” straw man, as it apparently served his purposes for his article.

“Did your factory work to engage you in any sort of improvement efforts? Did you have a voice? If not, that’s exactly what we’re trying to help improve with Lean.”

No and no, although what is sadder is that people who had been working there much longer than I had no voice either. But that’s neither here nor there, as what I was referring to was the boredom of factory work. I can imagine a factory where the “Grunt work” is not boring and repetitive, but I have to strain myself. Can you help me out and give me some examples? I will admit that I don’t read your blog and am not a manager so I don’t know what Lean is (I will do my due diligence and read some more), but I believe that human beings are naturally curious and creative, and being put in a situation where you are doing the same physical labor day in and day out for years just making enough to pay your living expenses for the month (so you can never really get ahead) just seems unescapably boring.

Well, there’s some element of repetitive “grunt work” in most any job. Nurses tend to do the same things day in and day out, although the patients and circumstances are different.

In really repetitive settings, Lean factories tend to deal with that boredom by doing very frequent job rotation or jobs are combined so that instead of just doing the same 45 seconds worth of work over and over, that you’re moving and actually doing more to build a complete product rather than just doing the same piece of work over and over.

Even if the work is relatively repetitive, the idea that you’re going to engage people (everyone) in improvement goes a long way toward building a more engaging workplace.

As for examples of these types of workplaces – see the post: Toyota, VIBCO, Nick’s Pizza & Pub, another one is FastCap in Bellingham, WA.

I read the article. The magazine is great but this particular writer was immature with his insights that went beyond factories. I thought the article was going to be about bringing the 1 million jobs back to America. What would that take or cost, could it be done. Or about the 90 million iphones and the environment.

Your points make sense to. Do you do anything in particular to get people to understand your vision when you start a new project?

The article that followed in WIRED was much better I thought, talking about moving jobs from China back to the U.S. and how factories can be competitive (although it focused a bit too much on robotics being the answer, but that’s a different nit to pick).

As for understanding the vision for lean, I think it’s a matter of talking with the front-line employees and the managers – teaching them about lean management concepts. The tough thing is that the transition to lean leadership requires a lot of coaching, not just a little bit of classroom education. Managers, in particular, are having to unlearn a lot of old habits.

Hey Mark-
I agree with you especially about Fast Cap. I love the way they operate and they have enough videos online so you can really get a feel for how they operate.

One of my favorites was that they ask EVERYONE to spend the first hour of every morning to try to innovate in their area. That way you always have time for it (since it’s first on your list) and nobody upstream is creating product and creating a queue for you.

I think the burger-flipping reference was an attempt to get people to put themselves in the shoes of overseas factory workers.

It’s true that many companies in America have much better working conditions than overseas corporations, but most Americans today by-and-large (at least all of the people I’ve talked to) don’t aspire to flip burgers for the rest of their life. Some people do, some people love food.

That being said, I think this article was pretty fairly written. Even if it creates cognitive dissonance the minds of readers, if the reader gets to the end of the article, at least they will have thought about the disparity between Western working conditions and Chinese working conditions. It makes you think about where we get our gadgets from.

Also, I have three friends that work in an American workshop assembling products for the medical field and they do work overtime on assembly lines. So I can empathize with this article.

Mark, your article is right on target. I am concerned, however, that much of the Lean implementation in healthcare focuses on addressing peripheral issues, such as delivering supplies to the nurses while the core of patient movement through the hospital is neglected. The highest value in improving the patient experience is in fundamentally changing how responsive healthcare is to patient needs, dramatically ending large queues, ER patients in the hallways, or recovery because there aren’t any beds in the hospital available. In some ways we are rearranging the deck chairs, while the Titannic is sinking because the tough issues are not being adequately addressed. Solving this critical problem would make the experience better for healthcare workers and patients. The critical barrier is patient release timing, and there is very limited attention to this issue.

Yes, Martin – that is a very important point. There are some hospitals using Lean to work on patient flow and, more importantly, quality outcomes and patient safety. For example, the recent Annals of Thoracic Surgery piece I highlighted:

ThedaCare, also, has reduced mortality for cardiac surgery patients, while also reducing cost and length of stay.

I had a friend tell me about a hospital where they had a Lean Six Sigma project on reducing the # of visitors who got through the E.D. without a visitor badge, yet the average length of stay was something like six hours. Which is the more important problem to solve?

That said, sometimes people have to start with relatively simple problems to develop their problem solving and change management skills….

Sorry, but I have been deep down in my ‘carbon factories’ kibitzing with the folks at the front, if you will, about continuous improvement in their tasks and procedures. Actually, they have been educating me with their suggestions to increase production without increasing risk and I have learned a great deal.

The author of the Wired article probably doesn’t get out of Marin as much as I do so the statements about factories were, as many above have already pointed out, sophomoric. The remarks were also totally fitting for those who while away their time at Peet’s Coffee in Mill Valley.

The description of Foxconn was chilling and sounded so much like the work environment at the Symonds Rolling Machine Company, which manufactured bicycle ball bearings in 1890’s Massachusetts and is described in so many case studies of worker abuse along with the tin sheet inspection line at Bethlehem Steel’s Sparrows Point plant near Baltimore.